Diagnostic Value of FDG PET-CT Quantitative Parameters and Deauville-Like 5 Point-Scale in Predicting Malignancy of Focal Thyroid Incidentaloma

Philippe Thuillier,Nathalie Roudaut,David Bourhis,Zarrin Alavi,Pierre-Yves Salaun,Geneviève Crouzeix,Ulrike Schick,Philippe Robin,Ronan Abgral,Véronique Kerlan

doi:10.3389/fmed.2019.00024

Philippe Thuillier, Nathalie Roudaut + Show 8 more

Open Access

https://doi.org/10.3389/fmed.2019.00024

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Abstract

Objective: To evaluate the diagnostic value of FDG PET-CT metabolic parameters and Deauville-like 5 point-scale to predict malignancy in a population of patients presenting focal thyroid incidentaloma (fTI).Design: This retrospective study included 41 fTI, classified according to cytological and histological data as benign (BL) or malignant lesion (ML). FDG PET-CT semi-quantitative parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG), tumor to liver SUVmean ratio (TLRmax and TLRmean), tumor to blood-pool SUVmean ratio (TBRmax and TBRmean) were calculated. Each fTI was also classified on a Deauville-like 5-point scale (DS) currently used in lymphoma. Comparison between BL and ML was performed for each parameter and a ROC analysis was conducted.Results: All quantitative PET metabolic parameters (SUV parameters, volume based parameters and SUV ratio) were higher in ML compared with BL, yet no significant difference was reported. fTI (uptake) malignancy rate according to DS grades 2, 3, 4, and 5 was, respectively, 25% (1 of 4), 28.6% (2 of 7), 8.3% (1 of 12), and 33.3% (6 of 18) with no significant difference between ML and BL groups. Results of ROC analysis showed that mean TBR had the highest AUC in our cohort (0.66 95%CI [0.41; 0.91]) with a cut-off value of 2.2. Specificity of MTV and TLG was 100% (cut-off values: MTV 9.6 ml, TLG 22.9 g) and their sensitivity was 30 and 40%, respectively.Conclusion: Our study did not highlight any FDG PET/CT parameter predictor of fTI malignancy.

Highlights

MATERIALS AND METHODSThyroid incidentaloma (TI) is a thyroid lesion fortuitously detected in patients undergoing an imaging for a non-thyroid purpose
All quantitative PET metabolic parameters (SUV parameters, volume based parameters and SUV ratio) were higher in malignant lesion (ML) compared with BL, yet no significant difference was reported. focal thyroid incidentaloma (fTI) malignancy rate according to Deauville-like 5-point scale (DS) grades 2, 3, 4, and 5 was, respectively, 25% (1 of 4), 28.6% (2 of 7), 8.3% (1 of 12), and 33.3% (6 of 18) with no significant difference between ML and BL groups
Results of ROC analysis showed that mean toBlood-pool Ratio (TBR) had the highest Area under the curve (AUC) in our cohort (0.66 95%CI [0.41; 0.91]) with a cut-off value of 2.2

Summary

Introduction

Thyroid incidentaloma (TI) is a thyroid lesion fortuitously detected in patients undergoing an imaging for a non-thyroid purpose. The common use of 18F-fluorodeoxyglucose (FDG) positron emission tomography—computed tomography (PETCT) in the field of oncology leads to a whole body imaging allowing the discovery of unexpected lesions. We published a prospective cohort study conducted on a population of 10,118 patients undergoing FDG PET-CT. Our previous results highlighted a fTI prevalence of 1.3% and a malignancy rate of 16.6% [1]. This prevalence was consistent with the literature whereas our malignancy rate was lower than that reported by recent meta-analyses [2, 3]

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